What can be done to treat Rheumatoid Arthritis?Doctors have learned a lot about RA in recent years, but they still don't know much more about how to truly cure the disease. They do have many medical strategies for treating the symptoms of RA. This treatment includes both medication as well as physical rehabilitation. If you start treatment within a few months after your symptoms appear, you will probably do better in the long-term. Early detection and treatment can help avoid the worst joint damage. Sudden remission does occur, but it's unclear how often, and it appears to be more likely within the first two years of the disease. Patients, who develop RA at a young age, are RF positive, have close relatives with RA, and have RA nodules tend to have a more difficult time managing the disease.

MedicationNonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, can help decrease the pain and swelling.

Corticosteroids taken by mouth can also help with inflammation but should not be used long term if at all possible due to the other problems they can cause in your body. Corticosteroid injections into the affected joints can ease the swelling and give immediate, short-term relief. Due to eye inflammation being so common with RA and difficult to diagnose, your doctor may also prescribe eye medications, even if you have no eye symptoms. Prophylactic eye drops can help prevent symptoms from developing or becoming severe when they start.

Disease-modifying antirheumatic drugs (DMARDs) are important in treating RA. It is not certain exactly how DMARDs actually slow or prevent the structural damage from RA, however, tests have shown all DMARDs to be effective. Unfortunately, DMARDs can be very hard on the body and can interact with other drugs. Often more than one DMARD is taken at the same time and it is not always easy to find the best combination of drugs that work for each individual.

Common DMARDs frequently prescribed are:

Hydroxychloroquine: A relatively nontoxic drug that was made to treat malaria. It can be safely used with other DMARDs. It is most useful in early, mild RA. Regular eye check-ups should be conducted while taking this drug.

Sulfasalazine: Much like hydroxychloroquine. This drug requires regular blood monitoring.

Gold salts: Can cause short-term remissions. Over the long-term, however, the RA does progress. Blood and urine monitoring are required.

Methotrexate: Can help manage RA, but it is unclear how much it actually changes the course of the disease. Methotrexate can be very useful over the long-term, but there are problems with flare-ups when patients stop taking it.

Azathioprine: Used with moderate and severe RA.

Penicillamine: Only used in patients who have systemic disease that doesn't respond well to other medications.

Cyclosporine: Expensive and hard on the kidneys, so it is most often used in severe RA.

Cyclophosphamide: Very effective but very toxic, so it is only used in specific cases.

Certain antibiotics are somewhat effective in mild cases.

Biologic response modifiers (BRMs) are among the newest drugs used to treat rheumatoid arthritis. They are genetically engineered proteins derived from human genes and are designed to inhibit specific components of the immune system that play pivotal roles in fueling inflammation, which is a central feature of rheumatoid arthritis.These agents inhibit key factors responsible for inflammatory responses in the immune system. Common biologics frequently prescribed are abatacept (Orencia), etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), and anakinra (Kineret).

Etanercept, infliximab and adalimumab are tumor necrosis factor (TNF) antagonists. TNF is responsible for both joint inflammation and other systemic inflammatory responses in RA patients.

Anakinra inhibits interleukin-1 (IL-1). Interleukin-1 in RA amplifies and perpetuates the inflammatory process related to the lining of the joints. This leads to the destruction of the cartilage and bones inside the joints.

Biologics are used to treat moderate to severe rheumatoid arthritis that has not responded adequately to other treatments. They differ significantly from traditional drugs used to treat rheumatoid arthritis in that they target specific components of the immune system instead of broadly affecting many areas of the immune system. Biologics may be used alone but are commonly given along with other rheumatoid arthritis medications. They have been shown to help slow progression of rheumatoid arthritis when all other treatments have failed to do so.

Abatacept (Orencia): Abatacept is given intravenously (IV) as an infusion over 30 minutes. During the first month, it is given every 2 weeks, then every 4 weeks thereafter. It may be used alone or with DMARDs.

Etanercept (Enbrel): Etanercept is taken as an injection once or twice a week. It may be used alone or with concomitant therapy such as methotrexate.

Infliximab (Remicade): Infliximab is given as a 2-hour intravenous infusion in a doctor’s office. Initially, 3 doses are given within a 6-week period; thereafter, a single dose is given every 8 weeks to maintain the drug’s effect. The interval between doses is shortened if the 8-week regimen fails to control symptoms. It is most often used with concomitant methotrexate.

Adalimumab (HUMIRA): Adalimumab is given as an injection every other week (or sometimes weekly). It is most often used with concomitant methotrexate.

RehabilitationAlthough there is no cure for RA, Physical Therapy can greatly assist with both the flare-ups as well as the potential long-term joint problems that can occur as a result of the disease. The main goals of our treatment at Staszak Physical Therapy & Wellness Center for RA are to relieve symptoms, preserve the function of your joints, prevent structural damage or deformity, and to assist you with maintaining a normal lifestyle.

RA is a frustrating and complex disease. At Staszak Physical Therapy & Wellness Center, we believe that the more you understand about the disease, the more effective our treatment will be. For this reason, education is an important part of our treatment for RA. By understanding the disease, you will also be better able to assist us in treating your own symptoms and preventing or managing flare-ups. Liaising with others who also have RA can be very insightful so we will assist in directing you to support groups or organizations that focus on living with RA.

As mentioned previously, the synovitis of the joints causes pain and over time can cause structural damage and deformities of the joints. During flare-ups the synovitis is actively occurring and is the source of pain. Our treatment at Staszak Physical Therapy & Wellness Center will therefore firstly focus on decreasing your pain.

Modalities such as heat or cold may be useful as well as other modalities such as transcutaneaous nerve stimulators (TENS.) These TENS machines assist with pain by delivering electrical currents through the painful area and work essentially to override the pain sensations. Your Physical Therapist may also suggest that you use hydrotherapy to ease the pain. During hydrotherapy your whole body, or just the affected joints, are immersed in warm water while gentle movements are performed. In many cases, this can significantly reduce the pain associated with an RA flare-up. Massage can also be very helpful to assist with flare-ups although not all patients with RA enjoy their painful joints being massaged, and this will be entirely respected. Sometimes with RA the most effective treatment during a flare-up is simply to rest the joint. Each joint has a natural resting position where the least amount of stress is placed on the tissues of the joint and therefore causes the least amount of pain. Your Physical Therapist at Staszak Physical Therapy & Wellness Center can advise you on the most effective resting position for any of your RA affected joints and can also advise you on when it is appropriate to begin exercise again after the rest period.

In addition to our Physical Therapy treatment, the medication that your doctor has prescribed will be especially important during flare-ups. Your Physical Therapist at Staszak Physical Therapy & Wellness Center may liaise closely with your doctor while treating you to ensure that all treatments are coinciding to most effectively relieve your pain. By limiting the length and intensity of the flare-ups, the synovitis has less time to cause structural damage to the joints and, therefore, less chance of causing a long-term deformity.

The next part of our treatment at Staszak Physical Therapy & Wellness Center will focus on preventing any deficits or deterioration in range of motion of your affected joints. Your Physical Therapist may assist in stretching your muscles while at the clinic and, if necessary, may ‘mobilize’ the joint. This hands-on technique encourages joints to move gradually into their normal range of motion and may also assist with pain relief. We will also prescribe a series of stretching exercises that we will encourage you to do as part of a home exercise program. The daily stretches and range of motion exercises done at home are often the most important part of treating RA as they work to both prevent and stop the progression of long-term deformities in the joint. If your joints have already developed some deformity then we will be particularly specific in teaching you range of motion exercises that take into consideration the abnormal position of the joint. Standard stretching exercises may cause deformities to progress if not adjusted to this consideration. Your Physical Therapist at Staszak Physical Therapy & Wellness Center will tailor a stretching program specifically for you.

Joints where deformity is likely to occur or that already show some deformation may require bracing or splinting to prevent further decline. Simple braces may be constructed by your Physical Therapist at Staszak Physical Therapy & Wellness Center but for more complex braces we will refer you to an occupational therapist, orthotist, or chiropodist to ensure a proper individualized brace or orthotic is constructed. Occupational therapists can also provide you with assistive devices, if needed, which make using a joint affected by RA easier and less painful. This in turns prevents the deterioration of the joint.

The muscles surrounding the affected RA joints can lose strength. The strength loss occurs both due to decreased use of the joints when they are painful, and also as a result of the altered pulling on the muscles when there are joint deformities. Similarly to the range of motion deficits, strength deficits will also be addressed during our treatment. Again, your Physical Therapist at Staszak Physical Therapy & Wellness Center will prescribe a series of strengthening exercises that we will encourage you to do as part of a home exercise program. These exercises will also be specifically tailored by our Physical Therapist to suit the needs of your affected joints.

Maintaining coordination of your RA joints is also an important part of maintaining normal function. Pain, inflammation, and joint deformity can all affect how well a joint works during functional activities such as grasping items or walking. In addition to the range of motion and strengthening exercises prescribed your Physical Therapist at Staszak Physical Therapy & Wellness Center will encourage coordination and proprioception exercises to ensure the joints do not lose normal function.

As a final component of our treatment, your Physical Therapist will discuss the benefits of some gentle aerobic exercise. Aerobic exercise such as swimming, walking or cycling can improve muscle endurance, aerobic capacity and improve your general well-being so is highly encouraged as part of an overall treatment plan for patients suffering with RA. Obviously, during times of flare-ups, aerobic exercise may not be possible, however when able, you should work to include it.

SurgeryAt least half of RA patients don't get effective relief from treatment and eventually need surgery on the affected joints. Surgery, including total joint replacement, can be a very effective way to help you overcome the pain and loss of movement of RA.

For most patients, RA is a disease that comes and goes throughout their lives but it doesn't have to be crippling. With the help of health care professionals such as your doctor and Physical Therapist, you should be able to find treatment that works for you and allows you to maintain a normal lifestyle.